Section 181-1-008 - PAYMENTPayment for pharmaceuticals and dialysis services must be approved by the Department. Claims may be approved for payment when all of the following conditions are met:
(A) A Chronic Renal Disease Program Service Provider Enrollment Form is on file with the Department for the entity claiming payment;(B) The client was approved for participation when the service was provided;(C) The services provided are covered services as described in this chapter; and(D) No more than six months have elapsed from the date of service until when the claim is received by the Chronic Renal Disease Program. Payment may be made by the Department for claims received more than six months after the date of service if the circumstances which delayed the submittal were beyond the provider's control. The Department may determine whether the circumstances were beyond the provider's control based on documentation submitted by the provider.008.01PROVIDER'S FAILURE TO COOPERATE IN SECURING THIRD-PARTY PAYMENT. The Department shall deny payment of a provider's claims if the provider fails to apply third-party payments to covered services, file necessary claims, or cooperate in matters necessary to secure payment by insurance or other responsible third-parties.008.02THIRD-PARTY REFUNDS. Whenever a service provider receives a third-party payment after a claim has been paid by the Department, the provider shall refund the Department for the full amount of the payment. The refund must be accompanied by a copy of the documentation, such as the Explanation of Benefits or electronic coordination of benefits.181 Neb. Admin. Code, ch. 1, § 008
Amended effective 6/14/2022